100 million COVID Infected Americans are the “Moses” that Will Deliver Us Beyond the Pandemic

  • Summary
  • The toll of this pandemic has been horrific throughout the world.
  • Remarkable sacrifices have been made that have limited its impact
  • Moving forward we need to understand how many people have been infected
  • If estimates are correct, we have significant immunity to COVID-19
  • Immunity will allow us to move forward from this pandemic
Our immune systems may be the Moses to lead us out of COVID!

Since both Passover and Easter are holidays of reflection and deliverance, I decided to reflect on the COVID-19 pandemic so far and discuss how we can be delivered beyond the time of coronavirus.

The impact of COVID–19 on the world and the United States has been horrific. Tens of thousands of people have become ill and died in a short period of time. Entire continents have been locked down and gripped by fear. These events serve as a stark reminder of the tenuous nature of life and the need to value every human being; important concepts that we might have been taking for granted.

Positives responses to the pandemic are often lost in the fever of the acute battle with the illness. Through remarkable sacrifices the pandemic was controlled in almost every country albeit at an enormous toll. This happened without violence or political upheaval and the vast majority of people tried to practice the public health initiatives that controlled the pandemic. This effort saved thousands of lives and that should not be forgotten moving forward.

So how do we move beyond the time of COVID-19. The raging debate about when and how to normalize activity, especially in United States, has led to widely opposing views even by knowledgeable individuals including former CDC and FDA directors. However, to make these decisions we need data. The biggest issue is that we don’t know what percentage of the population has been infected with COVID-19.

This number is crucial to moving forward. If a high percentage of the population is infected, it means significant herd immunity and indicates the case specific fatality rate is low. If a small percentage of the population has been infected, then the entire population is still at risk and the case-specific fatality rate is much higher. This potentially could make a second wave of the pandemic much worse. 

An important aside, I disagree with those arguing immunity is of little value. Antibody testing simply identifies those who have had an immune response; it may not be important itself as protection against the virus. People seem to forget that it is memory cellular immunity that is really important for protection from a virus. Focusing on antibody mediated viral neutralization to protect from future virus exposure is problematic. 

What follows comes from discussions I had this week with Dr. Eric Fearon, head of the University of Michigan’s Comprehensive Cancer Center.

One thing that is clear is this virus is very easily transmitted between people. Large amounts are in exhaled breath and many people who are infectious display no symptoms. Thus, many infections have occurred and most are asymptomatic. Given this, several of authoritative public health officials and biostatisticians have proposed the following scenario. 

Assuming that the current University of Washington modeling estimates of 60,000 deaths in US for this first wave, and an estimated mortality of 0.06%, similar to the worst seen for influenzathese 60,000 deaths means 100M have been infected in the US. One hundred million people is roughly a third of the US population. Can this be right? 

No one is sure, but a CDC study about community spread in early March and modeling from biostatisticians at Stanford (WSJ) argue that at least 3 million infected individuals were present in the US (1% of the population) around March 1.

With the doubling time of 3-4 days that was observe in testing in major cities for the two weeks prior to any significant social distancing, and the absence of social distancing in other parts of the country for many days more:

  • If 3M (1%) infected on March 1
  • 6M infected on March 5
  • 12M infected on March 9
  • 24M infected on March 13
  • 48M infected on March 17
  • 96M infected on March 24 (7-day doubling)
  • 192M infected on April 8 (15-day doubling due to social distancing)

Thus, while it is possible that 30%+ of the entire US population is COVID-19 exposed, it is more of a certainly that 30% or higher have been infected in high incidence areas like NYC, SE Michigan, NJ, CT, MA and New Orleans. 

Given this, our way forward beyond COVID is likely to be similar to the flu pandemic of 1918; based on our population immunity. If antibody numbers prove this out, we have a clearer and brighter future.

Published by jbakerjrblog

Immunologist, former Army MD, former head of allergy and clinical immunology at University of Michigan, vaccine developer and opinionated guy.

8 thoughts on “100 million COVID Infected Americans are the “Moses” that Will Deliver Us Beyond the Pandemic

  1. Dr Baker, I’ve followed your writing with interest and appreciation. I’ve linked to your posts, or quoted sections of them, several times in my own writing .

    I was surprised by your most recent post suggesting that 100M Americans could already be infected and that the IFR could be as low as 0.6%. While there have been a few papers and articles suggesting this high attack rate / low IFR scenario, they are very far from the mainstream view of most epidemiologists.

    I view our best current estimate of underreporting rate by country as this: https://cmmid.github.io/topics/covid19/severity/global_cfr_estimates.html.

    Extrapolating from this, even Italy only has something like 15% attack rate so far at a national level.

    And the one example we know of a country that has done widespread (though not truly random) testing of the asymptomatic population, Iceland, saw around 1% of asymptomatic people currently testing positive using PCR.

    Of course more people are or have been infected than are reported; and of course IFR will prove to be lower than CFR because of underreporting; but it seems highly unlikely that it is anywhere near 30% of the US population.

    Kind regards,

    Chris

    On Sun, Apr 12, 2020 at 8:24 PM Pandemic Pondering wrote:

    > jbakerjrblog posted: ” SummaryThe toll of this pandemic has been horrific > throughout the world.Remarkable sacrifices have been made that have limited > its impactMoving forward we need to understand how many people have been > infectedIf estimates are correct, we have significant ” >

    Like

    1. Many issues. We suffer a deficit of testing, and particularly in the US that is a problem. As testing has become more widespread the IFR has dropped substantially. See this one example. We won’t know for sure until blood testing is involved.

      https://www.technologyreview.com/2020/04/09/999015/blood-tests-show-15-of-people-are-now-immune-to-covid-19-in-one-town-in-germany/

      Even if eventual IFR is 1-1.5% the disease could still have infect 50-100M Americans by now given the doubling time in deaths (which remains higher than any other country).

      Like

  2. Thank you Dr. Baker for your contribution and all the time you are giving to those of us that truly want to understand the truth, even if it’s an educated guess at this point. I am following this everyday, and knowing who to trust has been quite a challenge.

    If you do not mind, I have a question. Above, if I understand you correctly, you are saying that an antibody test simply shows an immune response, not necessarily immunity from the virus. Yet, if we are to rely on antibody tests for a better understanding of the relative strength of the “herd” then this data presumes X% are immune from the virus, right? If the antibody test does not actually determine safety from the virus, then how is is useful in determining the value of the herd antibody test?

    Thank you again!

    Like

    1. Antibody test is the best we have right now. We need to do studies following antibody positive individuals exposed to virus to show they are protected. Primate studies have indicated this, but need to just make sure in humans.

      Like

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